Issue 32

Smoking              

Whilst it is still very important to remember the harm caused by cigarette smoking to the smoker and those around them, for those at Caswell there are a few other issues that are also important for those who smoke. Firstly the Welsh Assembly Government are right now considering whether to continue to allow smoking in mental health units such as Caswell. The decision is likely to be made early in the New Year but is quite likely to come down in favour of stopping patients smoking, as it is in England. This does not mean just in the building but within the grounds of the hospital also. For those who have been considering stopping for health reasons, this may help provide a bit more incentive but for those who do not plan on stopping through choice, it may be worth you giving it some thought now. 

Another important issue is that cigarette smoking can have a big impact on medication levels of anti-psychotics in particular. For example, the level of clozapine in a person's blood is up to a half less in smokers than non-smokers. This is important because it means that twice as much of the drug is required to get the same level as non-smokers. This is because the liver uses up the drug much more quickly in those who smoke. For those taking clozapine, the drug level will double if you give up smoking and this can, in some cases, be dangerous. It is, therefore, very important to plan things properly if you want to stop smoking. This is not a problem but if you are planning on stopping it is very important to inform your clinical team and they can make sure they check the levels and often will need to bring the dose down to even things out safely. We have had many patients give up smoking whilst at Caswell and can provide lots of different nicotine replacement treatments such as patches, lozenges and inhalators to help support you while you give up.

If the decision is made to stop patients smoking in hospitals it is important for those who have leaves to think about if they intend to smoke when on leave. This is because if you do not smoke in the hospital but then do when out on leaves, your drug levels will be up and down and obviously that means it can affect mental stability and that may go up and down too. This may cause you problems and may seem confusing and feel like you are struggling at times so it is worth thinking about in advance. We will not be able to stop anyone smoking while on leave so it will be up to you to think about if it is worth taking the risk of upsetting things just for a few cigarettes whilst out. Also if you start to smoke again when you leave Caswell we will have to think about putting the dose of some medications back up to have the same effect and monitor closely. All in all it can be a bit of a problem so if you do give up it is probably best to stay given up!! If you have any concerns about this then speak to a staff member or myself and we will help you to plan what is best for you. Stopping smoking is absolutely the best thing you can do for a million reasons but sometimes needs to be planned well to make sure there are no difficulties when you do. Good luck!

Simon.